Hysterosalpingogram

Test Overview

A hysterosalpingogram (HSG) is an
X-ray test. It looks at the inside of the
uterus and
fallopian tubes and the area around them. It often is
done for women who are having a hard time getting pregnant (infertile).

During the test, a dye (contrast material) is put through a thin tube. That tube is put through the vagina and
into the uterus. Because the uterus and the fallopian tubes are hooked
together, the dye will flow into the fallopian tubes. Pictures are taken using
a steady beam of X-ray (fluoroscopy) as the dye passes through
the uterus and fallopian tubes. The pictures can show problems such as an
injury or abnormal structure of the uterus or fallopian tubes. They can also show a blockage
that would prevent an egg moving through a fallopian tube to the uterus. A
blockage also could prevent sperm from moving into a fallopian tube and joining
(fertilizing) an egg. The test also may find problems on the
inside of the uterus that prevent a fertilized egg from attaching (implanting)
to the uterine wall.

Why It Is Done

A hysterosalpingogram (HSG) is done
to:

Check for a blocked fallopian tube. The test often
is done for a woman who is having a hard time getting pregnant. An infection
may cause severe scarring of the fallopian tubes and block the tubes. This can prevent pregnancy. Once in a while, the dye used during the HSG will push through and open a blocked tube.

Find problems in the
uterus, such as an abnormal shape or structure. The test can also look for an injury,
polyps,
fibroids,
adhesions, or a foreign object in the uterus. These
types of problems may cause painful menstrual periods or repeated
miscarriages.

See if tubal implants for permanent birth control are blocking the fallopian tubes.

Are allergic to the iodine dye
used or any other substance that has iodine. Also tell your doctor if you have
asthma or are allergic to any medicines. Tell him or her if you have had a
serious allergic reaction (anaphylaxis) from any substance. (For example, have you had a reaction to the venom from a bee sting or from eating shellfish?)

Have any bleeding problems or are taking any
blood-thinning medicines. Examples of these medicines are aspirin and warfarin
(Coumadin).

Have a history of kidney problems or
diabetes, especially if you take metformin (such as Glucophage) to control your diabetes. The dye used during the test can cause kidney damage in people with poor kidney
function. If you have a history of kidney problems, blood tests (creatinine,
blood urea nitrogen) may be done before the test. These check to see that
your kidneys are working well.

This test should be done 2 to 5 days after your menstrual period has ended. It should also be done before
you
ovulate the next month (unless you are using
contraception). This is to avoid using X-rays during an early pregnancy. You may want to
bring along a sanitary pad to wear after the test. That's because some leakage of
the X-ray dye may occur along with slight bleeding.

You may be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have about the need for the test, its
risks, how it will be done, or what the results will mean. To help you
understand the importance of this test, fill out the
medical test information form(What is a PDF document?).

How It Is Done

A hysterosalpingogram usually is done
by a
radiologist in the X-ray room of a hospital or clinic.
A radiology technologist and a nurse may help the doctor. A
gynecologist or a doctor who specializes in
infertility (reproductive endocrinologist) also may help with the
test.

Before the test begins, you may get a
sedative or ibuprofen (such as Advil) to help you
relax. This can also help relax your uterus so it will not cramp during the test. You will
need to take off your clothes below the waist and drape a gown around your
waist. You will empty your bladder. Then you will lie on your back on an exam
table. Your feet will be raised and supported by stirrups. This allows your doctor
to look at your genital area.

Your doctor
will put a smooth, curved tool called a speculum into your vagina. The speculum gently
spreads apart the vaginal walls. This allows the doctor to see the inside of the
vagina and the
cervix. The cervix may be held in place with a clamp
called a tenaculum. The cervix is washed with a special soap. A stiff tube
(cannula) or a flexible tube (catheter) is put through the cervix into the
uterus. The X-ray dye is put through the tube. If the fallopian tubes are open,
the dye will flow through them. It will then spill into the belly where it will be
absorbed by the body. If a fallopian tube is blocked, the dye will
not pass through. The X-ray pictures are shown on a TV screen during the test.
If another view is needed, the exam table may be tilted or you may be
asked to change position.

After the test, the cannula or catheter
and the speculum are removed. This test usually takes 15 to 30 minutes.

How It Feels

You will most likely feel some cramping like
menstrual cramps during the test. The amount of pain you have depends on what
problems the doctor finds and treats during the test.

Risks

There is always a small chance of damage to
cells or tissue from being exposed to any radiation. This can include the low levels
of radiation used for this test. The chance of damage from the X-rays is
generally very low compared with the possible benefits of the test.

There is a small chance of a pelvic infection after the test.
Examples of these are endometritis and
salpingitis. The chance may be higher
for women who have had pelvic infections before. Your doctor may give you
antibiotics if he or she thinks you might get a
pelvic infection.

There is a small chance of damaging or
puncturing the uterus or fallopian tubes during the test.

There is
a small chance of an
allergic reaction to the iodine X-ray dye. This is more common
if you are allergic to any shellfish.

In rare cases, if an
oil-based dye is used, the oil can leak into the blood. This can cause blockage
of blood flow to a section of the lung (pulmonary embolism). But in most cases, this test uses water-based dyes.

After the test

After the test, some of the dye
will leak out of the vagina. You also may have some vaginal bleeding for
several days after the test. Call your doctor right away if you have:

Heavy vaginal bleeding. (This means soaking more than one
tampon or pad in 1 hour.)

A fever.

Severe belly
pain.

Vaginal bleeding that lasts for more than 3 to 4 days.

Results

The shape of the uterus and
fallopian tubes are normal. The fallopian tubes are not scarred or damaged. The
dye flows freely from the uterus and through the fallopian tubes and then spills
normally into the belly.

What Affects the Test

You may not be able to
have the test, or the results may not be helpful, if:

Your fallopian tube has a spasm. This may
make a normal fallopian tube look blocked.

The doctor can't put
a catheter in the uterus.

This test is not done on women who are having their period,
are pregnant, or have a pelvic infection.

What To Think About

In some cases, a pelvic ultrasound test may be
done instead of a hysterosalpingogram (HSG) to find foreign objects in the uterus,
such as an intrauterine device (IUD). To learn more, see the topic
Pelvic Ultrasound.

An HSG is done mainly for women who are having a hard time getting pregnant. Some
studies show that this test may help a woman's chance of becoming pregnant. That is because the dye may remove the mucus plugs, straighten the fallopian tubes, and
break through thin scar tissue.

A hysteroscopy
may be done instead to look at the uterus. A test called a laparoscopy may also be done instead to
look at the fallopian tubes. A laparoscopy does not show whether the fallopian
tubes are open, unless dye is injected during the test.

Another test, called a
sonohysterogram (SHG), may be more accurate for
looking at uterine fibroids or polyps. SHG uses ultrasound to watch the
movement of a salt solution (saline) that is injected into the uterus. SHG does
not use X-rays or an iodine dye.

If a blocked fallopian tube is the cause of infertility, an
oil-based dye may be used during an HSG to remove the blockage.
Some studies show that an oil-based dye may open up a blockage better than a
water-based dye. Other studies have shown no difference between the two
dyes.

Be sure your doctor knows if you take metformin (such as Glucophage)
for diabetes or for any other reason, such as
polycystic ovary syndrome (PCOS). This is important because of the
possible interaction with the dye used in this test.

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